An Overview of Venous Insufficiency

The function of your veins is to take blood from your organs back to your heart. Because your legs are well below your heart, blood has to flow in an upward direction through your leg veins. To make sure that this blood doesn’t flow back downwards, your legs have one-way valves in them. It is when these valves aren't functioning properly that venous insufficiency occurs, as some of the blood will keep flowing back downward and pooling in the veins, causing symptoms.

Venous insufficiency is a very common condition and it affects an estimated 40% of adults. The chances of you having venous insufficiency increase as you get older. It is also more common in women than in men.

Additionally, even though venous insufficiency can affect your upper limbs (arms) too, it mostly occurs in the lower limbs (legs).

Other names for venous insufficiency are deep vein incompetence, chronic venous disease, or chronic venous insufficiency.

Symptoms

Most of the symptoms of venous insufficiency are mild, however, advanced stages of the condition may present more serious complications. Here are some of the common signs that you may have this condition:

• Heaviness in your leg(s)
• Swelling in the affected leg(s)
• Pain and/or tiredness in the affected leg(s)
• Varicose veins, which are veins that are enlarged, twisted, usually bluish, and visible from the surface of the skin
• Having strong urges to move your legs to relieve uncomfortable sensations/feelings in your legs, also known as restless legs syndrome
• Painful involuntary leg cramps or spasms
• Itchy skin
• Darkened, hard, and/or leathery-looking skin on the affected legs

In severe or advanced cases of venous insufficiency, skin ulcers or open sores may develop on the lower parts of your legs, usually near your ankles. These ulcers are called venous stasis ulcers.

These ulcers occur when the blood pressure and swelling increase to a point where your capillaries (tiny blood vessels) burst or get damaged, leading to a leakage of blood into the surrounding area. The skin there will then acquire yellowish and reddish patches that are visible under the skin, and it will also become very sensitive to damage.

Further, these damaged capillaries can cause tissue inflammation along with the ulcers. Unfortunately, not only are venous stasis ulcers difficult to heal, you could develop severe complications from them.

Causes

Venous insufficiency is caused by vein valves that aren’t functioning properly or a blockage in the veins. When this happens, blood flows back down in the legs instead of upwards to the heart. The flow in the wrong direction is also known as venous reflux.

Specific things that can cause venous insufficiency are:

• A blood clot in the deep veins of your legs. This condition is known as deep vein thrombosis (DVT), and it is the most common cause of venous insufficiency. In this case, the clot blocks the regular flow of blood, increasing the pressure inside the veins and this, in turn, stresses and eventually damages the vein valves.
• Standing or sitting for long periods of time can weaken the vein valves.
• Sometimes it's just part of the normal aging process.
• Congenital defects in the vein valves. What this means is that the problem with the valves has been present from birth.
• Lack of exercise or reduced mobility for a number of reasons like injury or aging.
• In rare cases, venous insufficiency is caused by pelvic tumors.

Sometimes there’s no traceable reason for why your vein valves become weak or fail to work properly.

There are some risk factors associated with venous insufficiency. You’re at a higher risk than the average person of developing venous insufficiency if you fall into any of these categories:

• Having May Thurner syndrome
• Being female
• Having a vein injury
• Engage in prolonged standing or sitting
• Being pregnant
• Smoking
• Having a family history of varicose veins
• Living a sedentary lifestyle
• Being over the age of 50

Diagnosis

To diagnose venous insufficiency, your healthcare provider will take into consideration your medical history and perform a complete physical examination on you, with a particular focus on your legs.

During this physical examination, your healthcare provider may also make use of a device called a Doppler to help with the diagnosis. Your healthcare provider may also ask you to provide information on your family's medical history.

Tests that may be ordered to diagnose venous insufficiency include:

Duplex Ultrasound

This test, which is also known as a vascular ultrasound, is used to check how well your vein valves are functioning. This test uses sound waves to determine how fast blood is flowing in your veins (and in what direction) and produce an image of your veins, with the aim of discovering what the actual cause/source of your venous insufficiency is. This is generally considered the best test to diagnose venous insufficiency

Magnetic Resonance (MR) Venography

This test can be used to obtain images of your venous system and check if you have deep vein thrombosis, that is, a blood clot in your deep veins. The use of an MR venography test is limited because if you have a metal implant in your body (as is common with many elderly people), you won’t be able to undergo it.

CT (Computed tomography) Venography

This test is generally used to obtain images of parts of your venous system that would be hard to see with a duplex ultrasound, either as a result of the actual location of the blockage or because of excessive swelling. It’s also less frequently used than the duplex ultrasound because it’s more expensive and it involves exposing you to some radiation and contrast dye.

Phlebography

Also known as venography, this is an invasive method of diagnosis that involves the injection of contrast dye into your veins through a catheter. Your healthcare provider will likely not order this test except if your diagnosis with a duplex ultrasound was inconclusive or you’re about to undergo surgery for this condition, and your venous system needs to be mapped out.

There are two kinds of phlebography—ascending and descending. The former is used to check for DVT while the latter is used to check for defects in your vein valves.

With the exception of the phlebography, these tests are painless and must be done while you’re standing, and if you’re unable to for a significant period of time, your results may be inaccurate.

These tests that may be carried out also help your healthcare provider decide what course of treatment is best for you.

Treatment

Because the major issue with venous insufficiency is lack of proper blood flow in the right direction, treatments for it are focused on that—getting the blood in your veins to flow right. Your healthcare provider will create a treatment plan to treat your venous insufficiency.

The treatment plan will take into consideration:

• Your age
• How advanced your venous insufficiency is, and its outlook
• The symptoms you are experiencing
• The current medications you are taking. This matters because certain medications that could be prescribed may have negative interactions with any you may be currently taking.
• Your general health and wellbeing

Self-Care Options

Your healthcare provider may instruct you to:

• Wear compression stockings. However, your healthcare provider will likely not prescribe compression stockings or any kind of compression therapy if you have venous ulcers that are infected or you have a medical history of congestive heart failure.
• Exercise more. Calf muscle pump exercises especially may be recommended.
• Keep your legs elevated (feet above thighs) to reduce swelling and pressure in them, and improve blood flow.
• Avoid standing or sitting for prolonged periods of time.

Medication

Your healthcare provider may also prescribe any or all of the following medication for you:

• Diuretics: Diuretics, also known as water pills, are drugs that are used to pull out excess fluid from the body through the kidneys. They may be prescribed to help teat the swelling, if any, associated with your venous insufficiency.
• Antibiotics: If you have open ulcers as a result of your venous insufficiency, your healthcare provider may prescribe antibiotics to treat them if infected.
• Pentoxifylline: This drug is usually prescribed in conjunction with compression therapy to heal venous ulcers faster.
• Anticoagulation medication: Also known as blood-thinning medication, anticoagulants may be prescribed.

Medical Treatments

• Endovenous laser ablation: This is a minimally invasive procedure that involves the use of laser heat through a catheter or cannula to heat up and seal the affected veins. Once blood can no longer pass through those veins, less blood pools there. Subsequently, flow is improved as the blood will be rerouted to other healthy/proper functioning veins. Endovenous laser treatment also gets rid of varicose veins and helps to heal venous ulcers. Local anesthesia is used for this procedure.
• Radiofrequency ablation: This is highly similar to endovenous laser therapy, with the only difference being radiofrequency energy will be the source of heat instead of lasers.
• Sclerotherapy: In this procedure, your affected veins will be injected with special chemical solutions. These chemicals will then cause the veins to scar, swell, and close up. Blood that previously used to pass through them will be rerouted to other healthy veins, and visible varicose veins disappear or at least fade considerably.

Surgery

There are different surgical options your healthcare provider may recommend for you:

• Ligation: This surgical procedure involves tying off the affected veins so that blood can no longer pass through them. If the venous insufficiency is very advanced and the veins have been seriously affected, the veins may be removed. This removal process is also known as "vein stripping."
• Surgical repair: This involves repairing the affected vein valves surgically. This can be done in many ways, and the most common is valvuloplasty, where the valve is tightened and repaired with stitches.
• Subfascial Endoscopy Perforator Surgery: This procedure is used to treat venous insufficiency if the damaged veins are perforator veins—veins that connect the superficial veins to the deep veins in your body. Small incisions are made into your calf and these perforator veins are blocked off using surgical clips.
• Vein bypass: This involves surgically removing healthy veins from one part of the body and transplanting it to the part of the body where the veins affected by venous insufficiency are located, and the blood flow is rerouted to the newly transplanted veins. This option is not commonly resorted to unless other treatments have been unsuccessful.

Coping

Venous insufficiency is usually a chronic condition, which means if you have it, you'll likely be living with it for the rest of your life. Treatments for it mainly reduce your symptoms and don't usually eliminate them completely, so you'll have to make a few changes to your lifestyle. So asides from quitting smoking and trying to live a more active lifestyle, you may have to make adjustments to how you carry out your day-to-day work.

For example, if your job requires you to sit or stand for long periods of time, finding alternatives while still being efficient will become imperative. Or if you're used to carrying out heavy housework at home, you may have to ease up on that. Discussing how your current lifestyle is structured with your healthcare provider will help both of you decide on the necessary and feasible changes you may have to make to it.

A Word From Verywell

It’s normal to feel anxious or even worried if you’ve been diagnosed with venous insufficiency. However, it is usually not life-threatening and with the right treatment plan designed by your healthcare provider (and of course followed by you), you should be just fine. Be sure to report any changes in your symptoms to your healthcare provider to prevent the condition from progressing and worsening. And lastly, make sure to incorporate the important lifestyle changes, especially exercising more, into your daily routine.